face and neck cystic lymphangioma resection

Cystic lymphangioma (also known as cystic water tumor) should be surgically removed as soon as possible after diagnosis. However, cystic lymphangioma often extends deep into the neck and surrounds the important anatomical structures of the neck such as nerves, blood vessels, trachea, esophagus, etc., up to the parapharyngeal area of the skull, and can extend down to the mediastinum of the thoracic cavity, causing breathing, hard to swallow. These features increase the complexity and risk of surgery. Therefore, the age of surgery should be 2 years or older. When cystic lymphangioma surrounds the thoracic trachea, esophagus, apex and large vessels, resection of the tumor in the thoracic cavity is quite difficult and dangerous, especially in young children. In such cases, the neck tumor can be removed first, and the residual tumor in the thoracic cavity can be followed up, because the residual tumor in the thoracic cavity tends to shrink on its own. Treatment of diseases: cystic lymphangioma Indication Cystic lymphangioma (also known as cystic water tumor) should be surgically removed as soon as possible after diagnosis. However, cystic lymphangioma often extends deep into the neck and surrounds the important anatomical structures of the neck such as nerves, blood vessels, trachea, esophagus, etc., up to the parapharyngeal area of the skull, and can extend down to the mediastinum of the thoracic cavity, causing breathing, hard to swallow. These features increase the complexity and risk of surgery. Therefore, the age of surgery should be 2 years or older. When cystic lymphangioma surrounds the thoracic trachea, esophagus, apex and large vessels, resection of the tumor in the thoracic cavity is quite difficult and dangerous, especially in young children. In such cases, the neck tumor can be removed first, and the residual tumor in the thoracic cavity can be followed up, because the residual tumor in the thoracic cavity tends to shrink on its own. Contraindications Infants under the age of 2, especially those with weak constitution, should not be operated. Patients with tumor co-infection or pulmonary infection are also not suitable for surgery. In the latter category, anti-infective treatment should be given first. Preoperative preparation Cystic lymphangioma can cause laryngeal and tracheal displacement, resulting in difficulty in endotracheal intubation, so the anesthesiology should be consulted before surgery, and tracheotomy should be prepared. Preoperative blood matching. In addition, it is necessary to prepare for general routine preoperative, if necessary, intracapsular puncture, a small amount of cystic fluid, and injection of the same amount of methylene blue solution, which is beneficial to the identification of normal tissues during surgery. Surgical procedure Incision The design of the incision varies depending on the size of the tumor. For large tumors, a transverse fusiform incision should be made in the direction of the skin. The length of the incision and the amount of skin removed depend on the size of the tumor. Generally, the ends of the incision should be slightly beyond the edge of the tumor. The scope of the skin should be strictly controlled. Only too much skin should be removed, and it should not be removed too much. If the tumor is small, only a curved incision can be made, and it is not necessary to remove the skin. 2. Reveal the tumor The skin, subcutaneous tissue and platysma can be cut along the incision, and the external jugular vein can be ligated and cut to reveal the superficial cystic lymphangioma. Then, the cervical flap is peeled upward and downward on the deep side of the platysma, and the peeling range is more than the edge of the tumor, but when it is peeled off, it can be peeled off to the upper edge of the clavicle. The sternocleidomastoid muscle is then severed and the sternocleidomastoid muscle is removed upward and downward, respectively. At this point, the superficial surface of the tumor is completely exposed to the field of view. If the tumor is located in the posterior aspect of the sternocleidomastoid muscle and in the posterior triangle of the neck, it is not necessary to cut off the sternocleidomastoid muscle, and peel it off properly and pull it back to the inside to reveal the tumor front. 3. Stripping the tumor The tumor has a complete capsule, generally above the clavicle, at the lower edge of the tumor, close to the capsule for sharp or blunt separation. In the deep neck, tumors often surround the important anatomical structures of the neck such as the common carotid artery, internal jugular vein, vagus nerve, accessory nerve, etc., even between the brachial plexus and the muscle abdomen, or deep into the surface of the pleural apex. Therefore, it is necessary to separate and protect these important structures under direct vision, and then carefully and carefully strip the tumor (Figure 10.4.2.2.3-5 to 10.4.2.2.3-9). In the anterior portion of the neck, the tumor can wrap around the larynx, trachea, and esophagus, and it must be carefully separated to avoid damage to these important structures. In addition, the recurrent laryngeal nerve is ascending along the trough formed by the trachea and esophagus, and penetrates into the larynx on the posterior side of the cuff joint. When the tumor is removed from the site, the recurrent laryngeal nerve should be damaged. In the upper neck, the tumor often surrounds the internal and external arteries, the hypoglossal nerve and the second abdominal muscles, and can extend to the base of the skull. It is also necessary to carefully protect these important structures under clear vision and carefully peel them off. Until the tumor is completely removed. 4. Wound treatment After rinsing the wound with saline, carefully look for the bleeding point and ligation one by one to completely stop the bleeding. A rubber sheet or a half tube drainage strip is placed in the wound to suture the platysma and skin. Gently pressurize the dressing. complication The main complications of cystic lymphangioma resection in the neck and neck are important anatomical damage to the neck and residual cyst wall leading to postoperative recurrence. The preventive measures are described in the points of attention during the operation. In addition, prevention of upper airway obstruction and pneumonia must be prevented. Especially when the tumor wraps around the larynx, trachea and esophagus or infants and young children, it is necessary to make a tracheostomy and then perform surgical resection of the tumor.